Podcast
Questions and Answers
True or false: Hypertension is defined as a sustained systolic blood pressure of greater than 140 mm Hg or a sustained diastolic blood pressure of greater than 90 mm Hg?
True or false: Hypertension is defined as a sustained systolic blood pressure of greater than 140 mm Hg or a sustained diastolic blood pressure of greater than 90 mm Hg?
True
True or false: Sustained arterial hypertension damages blood vessels in the kidney, heart, and brain, leading to an increased incidence of renal failure, coronary disease, heart failure, stroke, and dementia?
True or false: Sustained arterial hypertension damages blood vessels in the kidney, heart, and brain, leading to an increased incidence of renal failure, coronary disease, heart failure, stroke, and dementia?
True
True or false: Effective pharmacologic lowering of blood pressure has been shown to prevent damage to blood vessels and to substantially reduce morbidity and mortality rates?
True or false: Effective pharmacologic lowering of blood pressure has been shown to prevent damage to blood vessels and to substantially reduce morbidity and mortality rates?
True
True or false: There are six main drug classes recommended for the treatment of hypertension?
True or false: There are six main drug classes recommended for the treatment of hypertension?
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ACE inhibitors are added after improving the treatment with diuretics
ACE inhibitors are added after improving the treatment with diuretics
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Beta blockers are added after improving ACE inhibitors or treatment
Beta blockers are added after improving ACE inhibitors or treatment
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Aldosterone antagonists and fixed doses of hydralazine and isosorbide dinitrate are started in patients who continue to have symptoms despite optimal doses of ACE inhibitors and beta blockers
Aldosterone antagonists and fixed doses of hydralazine and isosorbide dinitrate are started in patients who continue to have symptoms despite optimal doses of ACE inhibitors and beta blockers
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Once a patient has taken the optimal dose of ACE inhibitor and still experiences symptoms, either can be replaced with sacubitril/valsartan
Once a patient has taken the optimal dose of ACE inhibitor and still experiences symptoms, either can be replaced with sacubitril/valsartan
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Digoxin and ivabradine are added to achieve symptomatic benefit only in patients undergoing optimal drug therapy for high frequency rate
Digoxin and ivabradine are added to achieve symptomatic benefit only in patients undergoing optimal drug therapy for high frequency rate
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ACE inhibitors are not added after improving the treatment with diuretics
ACE inhibitors are not added after improving the treatment with diuretics
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Beta blockers are not added after improving ACE inhibitors or treatment
Beta blockers are not added after improving ACE inhibitors or treatment
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Aldosterone antagonists and fixed doses of hydralazine and isosorbide dinitrate are not started in patients who continue to have symptoms despite optimal doses of ACE inhibitors and beta blockers
Aldosterone antagonists and fixed doses of hydralazine and isosorbide dinitrate are not started in patients who continue to have symptoms despite optimal doses of ACE inhibitors and beta blockers
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ACE inhibitors and ARBs are two classes of drugs used to treat hypertension and heart failure.
ACE inhibitors and ARBs are two classes of drugs used to treat hypertension and heart failure.
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ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, resulting in decreased blood pressure and decreased salt and water retention.
ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, resulting in decreased blood pressure and decreased salt and water retention.
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ARBs block the action of angiotensin II at its receptor, thus decreasing blood pressure and decreasing salt and water retention.
ARBs block the action of angiotensin II at its receptor, thus decreasing blood pressure and decreasing salt and water retention.
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Renin inhibitors act earlier in the renin-angiotensin-aldosterone system than ACE inhibitors or ARBs.
Renin inhibitors act earlier in the renin-angiotensin-aldosterone system than ACE inhibitors or ARBs.
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ACE inhibitors are primarily eliminated by the kidneys.
ACE inhibitors are primarily eliminated by the kidneys.
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ARBs are fetotoxic.
ARBs are fetotoxic.
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Renin inhibitors directly inhibit angiotensin II.
Renin inhibitors directly inhibit angiotensin II.
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ACE inhibitors, ARBs, and renin inhibitors are safe to use during pregnancy.
ACE inhibitors, ARBs, and renin inhibitors are safe to use during pregnancy.
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ARBs are a more attractive therapy for hypertensive diabetics due to their higher nephrotoxicity compared to ACE inhibitors.
ARBs are a more attractive therapy for hypertensive diabetics due to their higher nephrotoxicity compared to ACE inhibitors.
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Enalaprilat is the only drug in the class of ACE inhibitors available intravenously.
Enalaprilat is the only drug in the class of ACE inhibitors available intravenously.
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Losartan is the prototypic ARB, and there are six other ARBs currently available: Valsartan, Telmisartan, Losartan, Irbesartan, Azilsartan, and Olmesartan.
Losartan is the prototypic ARB, and there are six other ARBs currently available: Valsartan, Telmisartan, Losartan, Irbesartan, Azilsartan, and Olmesartan.
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β-blockers are primarily used in hypertensive patients with heart disease, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, and chronic heart failure
β-blockers are primarily used in hypertensive patients with heart disease, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, and chronic heart failure
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ACE inhibitors and ARBs are used in the treatment of acute coronary syndrome, including acute myocardial infarction and unstable angina pectoris.
ACE inhibitors and ARBs are used in the treatment of acute coronary syndrome, including acute myocardial infarction and unstable angina pectoris.
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Conditions that discourage β-blocker use include reversible bronchospastic diseases, second- and third-degree heart block, and severe peripheral vascular disease
Conditions that discourage β-blocker use include reversible bronchospastic diseases, second- and third-degree heart block, and severe peripheral vascular disease
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Propranolol undergoes extensive first-pass metabolism and may take several weeks to develop full effects
Propranolol undergoes extensive first-pass metabolism and may take several weeks to develop full effects
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β-blockers may cause bradycardia, CNS side effects (fatigue, lethargy, insomnia, hallucinations), and hypotension
β-blockers may cause bradycardia, CNS side effects (fatigue, lethargy, insomnia, hallucinations), and hypotension
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Prazosin, doxazosin, and terazosin competitively block $α_1$ adrenoceptors, decreasing peripheral vascular resistance and lowering arterial blood pressure
Prazosin, doxazosin, and terazosin competitively block $α_1$ adrenoceptors, decreasing peripheral vascular resistance and lowering arterial blood pressure
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Direct-acting smooth muscle relaxants like hydralazine and minoxidil dilate blood vessels
Direct-acting smooth muscle relaxants like hydralazine and minoxidil dilate blood vessels
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Heart failure is classified into four stages, and treatment varies from diuretics for volume overload to polytherapy for persistent symptoms
Heart failure is classified into four stages, and treatment varies from diuretics for volume overload to polytherapy for persistent symptoms
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Minoxidil treatment can cause hypertrichosis and is used topically for male pattern baldness
Minoxidil treatment can cause hypertrichosis and is used topically for male pattern baldness
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In heart failure patients on optimal therapy, Sacubitril/valsartan, digoxin, and Ivabradine may be added for symptomatic benefit
In heart failure patients on optimal therapy, Sacubitril/valsartan, digoxin, and Ivabradine may be added for symptomatic benefit
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True or false: Calcium channel blockers (CCBs) are not recommended for hypertensive patients with diabetes or angina.
True or false: Calcium channel blockers (CCBs) are not recommended for hypertensive patients with diabetes or angina.
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True or false: High doses of short-acting CCBs should be avoided due to increased risk of myocardial infarction.
True or false: High doses of short-acting CCBs should be avoided due to increased risk of myocardial infarction.
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True or false: Verapamil is the only member of the Benzothiazepines class approved in the US.
True or false: Verapamil is the only member of the Benzothiazepines class approved in the US.
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True or false: Dihydropyridines have a much greater affinity for heart calcium channels than vascular calcium channels.
True or false: Dihydropyridines have a much greater affinity for heart calcium channels than vascular calcium channels.
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True or false: Most CCBs have long half-lives, making them suitable for once-daily dosing.
True or false: Most CCBs have long half-lives, making them suitable for once-daily dosing.
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True or false: Adverse effects of CCBs include constipation, dizziness, headache, and fatigue.
True or false: Adverse effects of CCBs include constipation, dizziness, headache, and fatigue.
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True or false: Verapamil should be avoided in patients with congestive heart failure or atrioventricular block due to its positive inotropic effect.
True or false: Verapamil should be avoided in patients with congestive heart failure or atrioventricular block due to its positive inotropic effect.
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True or false: β-Blockers are not a treatment option for hypertensive patients with concomitant heart disease or heart failure.
True or false: β-Blockers are not a treatment option for hypertensive patients with concomitant heart disease or heart failure.
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True or false: β-Blockers primarily decrease blood pressure by reducing peripheral vascular resistance.
True or false: β-Blockers primarily decrease blood pressure by reducing peripheral vascular resistance.
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ACE inhibitors block the ACE enzyme responsible for producing the vasoconstrictor angiotensin II and decrease aldosterone secretion, leading to decreased sodium and water retention.
ACE inhibitors block the ACE enzyme responsible for producing the vasoconstrictor angiotensin II and decrease aldosterone secretion, leading to decreased sodium and water retention.
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Common side effects of ACE inhibitors include dry cough, rash, fever, altered taste, hypotension, and hyperkalemia.
Common side effects of ACE inhibitors include dry cough, rash, fever, altered taste, hypotension, and hyperkalemia.
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ACE inhibitors, ARBs, beta-blockers, CCBs, and diuretics work by different mechanisms to reduce blood pressure and improve cardiovascular health.
ACE inhibitors, ARBs, beta-blockers, CCBs, and diuretics work by different mechanisms to reduce blood pressure and improve cardiovascular health.
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The benefits of ACE inhibitors, ARBs, beta-blockers, CCBs, and diuretics in managing blood pressure far outweigh the risks, even in patients with chronic kidney disease.
The benefits of ACE inhibitors, ARBs, beta-blockers, CCBs, and diuretics in managing blood pressure far outweigh the risks, even in patients with chronic kidney disease.
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ACE inhibitors, such as Enalapril, Captopril, and Lisinopril, are recommended as first-line treatment for hypertension in patients with a high risk of coronary disease, diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease.
ACE inhibitors, such as Enalapril, Captopril, and Lisinopril, are recommended as first-line treatment for hypertension in patients with a high risk of coronary disease, diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease.
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Medications that lower blood pressure prevent damages to the kidneys, heart, brain, and other organs leading to conditions such as chronic kidney disease, heart failure, and strokes.
Medications that lower blood pressure prevent damages to the kidneys, heart, brain, and other organs leading to conditions such as chronic kidney disease, heart failure, and strokes.
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Various classes of drugs are available for blood pressure management.
Various classes of drugs are available for blood pressure management.
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Mlm Zebq (a type of mineral oil) can cause damage to the kidneys, heart, brain, and other organs leading to conditions such as chronic kidney disease, heart failure, and strokes.
Mlm Zebq (a type of mineral oil) can cause damage to the kidneys, heart, brain, and other organs leading to conditions such as chronic kidney disease, heart failure, and strokes.
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Persistent low or high blood pressure can cause damage to the kidneys, heart, brain, and other organs leading to conditions such as chronic kidney disease, heart failure, and strokes.
Persistent low or high blood pressure can cause damage to the kidneys, heart, brain, and other organs leading to conditions such as chronic kidney disease, heart failure, and strokes.
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ARBs, beta-blockers, CCBs, diuretics, and other groups of drugs are also recommended for the treatment of hypertension.
ARBs, beta-blockers, CCBs, diuretics, and other groups of drugs are also recommended for the treatment of hypertension.
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The choice of medication for hypertension is based on its proven ability to reduce blood pressure, evidence from placebo-controlled studies that they reduce cardiovascular events, and evidence of broad equivalence on overall cardiovascular morbidity and mortality.
The choice of medication for hypertension is based on its proven ability to reduce blood pressure, evidence from placebo-controlled studies that they reduce cardiovascular events, and evidence of broad equivalence on overall cardiovascular morbidity and mortality.
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High doses of short-acting CCBs should be avoided due to increased risk of myocardial infarction.
High doses of short-acting CCBs should be avoided due to increased risk of myocardial infarction.
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What are the two traditional classifications of acid-base disturbances?
What are the two traditional classifications of acid-base disturbances?
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Which acid is known as a volatile acid, capable of escaping as a gas?
Which acid is known as a volatile acid, capable of escaping as a gas?
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In respiratory acidosis, what may cause hypoventilation?
In respiratory acidosis, what may cause hypoventilation?
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What are the four classes of acid-base disorders?
What are the four classes of acid-base disorders?
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Which condition may result in hypercapnoeic acidosis due to decreased alveolar ventilation and PaCO2 >6.0?
Which condition may result in hypercapnoeic acidosis due to decreased alveolar ventilation and PaCO2 >6.0?
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In anaesthesia, hypercapnoeic acidosis may also occur due to:
In anaesthesia, hypercapnoeic acidosis may also occur due to:
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What term is used when the kidneys increase HCO3 reabsorption to compensate for persistent respiratory acidosis?
What term is used when the kidneys increase HCO3 reabsorption to compensate for persistent respiratory acidosis?
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Which condition may lead to raised plasma HCO3 concentration (>26 mmol/L)?
Which condition may lead to raised plasma HCO3 concentration (>26 mmol/L)?
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What characterizes metabolic acidosis?
What characterizes metabolic acidosis?
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What leads to metabolic acidosis with low plasma HCO3 concentration?
What leads to metabolic acidosis with low plasma HCO3 concentration?
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Which group of medications work by different mechanisms to reduce blood pressure and improve cardiovascular health?
Which group of medications work by different mechanisms to reduce blood pressure and improve cardiovascular health?
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What class of drugs are recommended as first-line treatment for hypertension in high-risk patients?
What class of drugs are recommended as first-line treatment for hypertension in high-risk patients?
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'ARBs' block the action of which substance at its receptor to decrease blood pressure and salt and water retention?
'ARBs' block the action of which substance at its receptor to decrease blood pressure and salt and water retention?
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What medication can cause hypertrichosis and is used topically for male pattern baldness?
What medication can cause hypertrichosis and is used topically for male pattern baldness?
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What drug class competitively blocks $α_1$ adrenoceptors, decreasing peripheral vascular resistance and lowering arterial blood pressure?
What drug class competitively blocks $α_1$ adrenoceptors, decreasing peripheral vascular resistance and lowering arterial blood pressure?
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What characterizes metabolic acidosis?
What characterizes metabolic acidosis?
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What condition may result in hypercapnoeic acidosis due to decreased alveolar ventilation and PaCO2 >6.0?
What condition may result in hypercapnoeic acidosis due to decreased alveolar ventilation and PaCO2 >6.0?
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Which group of medications work by different mechanisms to reduce blood pressure and improve cardiovascular health?
Which group of medications work by different mechanisms to reduce blood pressure and improve cardiovascular health?
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What are the two traditional classifications of acid-base disturbances?
What are the two traditional classifications of acid-base disturbances?
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What may cause hypercapnoeic acidosis with PaCO2 >6.0?
What may cause hypercapnoeic acidosis with PaCO2 >6.0?
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What term is used when the kidneys increase HCO3 reabsorption to compensate for persistent respiratory acidosis?
What term is used when the kidneys increase HCO3 reabsorption to compensate for persistent respiratory acidosis?
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What characterizes metabolic acidosis?
What characterizes metabolic acidosis?
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Which condition may lead to raised plasma HCO3 concentration (>26 mmol/L)?
Which condition may lead to raised plasma HCO3 concentration (>26 mmol/L)?
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What may cause hypoventilation in respiratory acidosis?
What may cause hypoventilation in respiratory acidosis?
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What leads to metabolic acidosis with low plasma HCO3 concentration?
What leads to metabolic acidosis with low plasma HCO3 concentration?
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What medication can cause hypertrichosis and is used topically for male pattern baldness?
What medication can cause hypertrichosis and is used topically for male pattern baldness?
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True or false: Sustained arterial hypertension damages blood vessels in the kidney, heart, and brain, leading to an increased incidence of renal failure, coronary disease, heart failure, stroke, and dementia?
True or false: Sustained arterial hypertension damages blood vessels in the kidney, heart, and brain, leading to an increased incidence of renal failure, coronary disease, heart failure, stroke, and dementia?
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What are the four classes of acid-base disorders?
What are the four classes of acid-base disorders?
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Which acid is known as a volatile acid, capable of escaping as a gas?
Which acid is known as a volatile acid, capable of escaping as a gas?
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What term is used when the kidneys increase HCO3 reabsorption to compensate for persistent respiratory acidosis?
What term is used when the kidneys increase HCO3 reabsorption to compensate for persistent respiratory acidosis?
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What may cause hypercapnoeic acidosis with PaCO2 >6.0?
What may cause hypercapnoeic acidosis with PaCO2 >6.0?
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Study Notes
-
Calcium channel blockers (CCBs) are recommended for hypertensive patients with diabetes or angina.
-
High doses of short-acting CCBs should be avoided due to increased risk of myocardial infarction.
-
CCBs are divided into three chemical classes: Diphenylalkylamines (Verapamil), Benzothiazepines (Diltiazem), and Dihydropyridines (Nifedipine, Amlodipine, etc.).
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Verapamil is the only member of the Diphenylalkylamines class approved, while Diltiazem is the only member of the Benzothiazepines class approved in the US.
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Dihydropyridines have a much greater affinity for vascular calcium channels than heart calcium channels, making them beneficial in treating hypertension.
-
Most CCBs have short half-lives (3-8 hours after oral doses), but sustained-release preparations are available for once-daily dosing.
-
Adverse effects include constipation (approximately 10% with Verapamil), dizziness, headache, and fatigue (more frequent with dihydropyridines).
-
Verapamil should be avoided in patients with congestive heart failure or atrioventricular block due to its negative inotropic effect.
-
β-Blockers (Propranolol, Metoprolol, Esmoprolol) are a treatment option for hypertensive patients with concomitant heart disease or heart failure.
-
β-Blockers primarily decrease blood pressure by reducing cardiac output.
-
Mlm Zebq (a type of mineral oil) and persistent low or high blood pressure can cause damage to the kidneys, heart, brain, and other organs leading to conditions such as chronic kidney disease, heart failure, and strokes.
-
Medications that lower blood pressure prevent these damages and significantly reduce the risk of cardiovascular events. Various classes of drugs are available for blood pressure management.
-
ACE inhibitors, such as Enalapril, Captopril, and Lisinopril, are recommended as first-line treatment for hypertension in patients with a high risk of coronary disease, diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease.
-
ACE inhibitors block the ACE enzyme responsible for producing the vasoconstrictor angiotensin II and decrease aldosterone secretion, leading to decreased sodium and water retention. They reduce both cardiac preload and afterload, decreasing cardiac work.
-
Common side effects of ACE inhibitors include dry cough, rash, fever, altered taste, hypotension, and hyperkalemia. The dry cough may be due to increased bradykinin levels in the lungs.
-
ARBs (angiotensin II receptor blockers), beta-blockers, CCBs (calcium channel blockers), diuretics (thiazides and thiazide-like diuretics), and other groups of drugs are also recommended for the treatment of hypertension.
-
The choice of medication is based on its proven ability to reduce blood pressure, evidence from placebo-controlled studies that they reduce cardiovascular events, and evidence of broad equivalence on overall cardiovascular morbidity and mortality.
-
ACE inhibitors, ARBs, beta-blockers, CCBs, and diuretics work by different mechanisms to reduce blood pressure and improve cardiovascular health.
-
The benefits of these classes of drugs in managing blood pressure far outweigh the risks, even in patients with chronic kidney disease, and their use is associated with improved cardiovascular outcomes and reduced mortality.
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Description
Test your knowledge on the use of calcium-channel blockers as a treatment option for hypertensive patients with diabetes or angina, and learn about the classes of calcium-channel blockers and their potential risks.
